Bleeding after the birth of your baby is very normal. It is usually heaviest for the first 7 to 10 days and then begins to taper off. It is initially quite red & then changes to pink and then a brownish colour. This blood loss is often described as “Lochia”. It can stop and then start again anytime in the 6 weeks after the baby is born and be pinkish/brownish & a light flow or spotting. There are some women that will have some spotting or very light discharge up until 8 weeks. In the final healing stage the discharge becomes yellowish white. If bleeding continues after this time please see a medical practitioner for review.
POST PARTUM HAEMORRHAGE (PPH)
If bleeding has stopped and started again it should not be heavy. If soaking a pad or more in an hour or passing large clots after discharge from hospital, please call the hospital immediately. This bleeding could be a sign of a post partum haemorrhage (PPH) and immediate medical attention is always required. A PPH can be the result of a uterine infection or retained placental tissue or membranes. Hospitalisation is nearly always required as blood loss can be significant. Some women will require surgery to remove retained tissue & others will only require intravenous medication to treat the infection and replace fluids due to blood loss. In some instances a blood transfusion would be required. Normally bleeding will start again after being discharged from hospital as the woman becomes more active and the healing process continues. The bleeding will be bright/pink or brownish and a light flow and normally stops around 6 weeks or before as described above.
During this recovery 6 weeks, the uterus returns to its normal non pregnant size & the placental site fully heals. Women who have had their second, third or fourth baby may experience ‘after pains’ when they are breastfeeding. This feels like a contraction & can be terribly painful for some women. It will almost always resolve within a day or two. Pain relief such as paracetamol & a non steroidal anti inflammatory medication prior to breastfeeding will help as will a heat pack applied to the low abdomen & or back.
The perineum will be swollen & there maybe stitches. The area has been stretched & grazed & there may have been a tear or an episiotomy incision. The swelling & engorgement (blood & fluid filled tissue) of the vulva/perineum & vaginal walls following the birth is very normal but can be very uncomfortable in the first two weeks. Keep the area clean & dry by showering twice a day & changing pads every couple of hours. Ice packs may be useful in the first 48 hours to help with swelling. Pain relief will be prescribed in hospital. Avoid long periods of standing & no heavy lifting. The swelling will usually resolve within 3 weeks. Any stitches are absorbable & most women will find at 3 weeks all is healing well. If there is any increase in pain or discharge & or ooze from the sutured area or an unpleasant odour please seek medical advice. The muscle tone will in most cases be much improved by 6 weeks but it will take a further few months for most women to return to normal. Some women will require follow up with a physio to continue to improve the pelvic floor tone. If concerned about any pelvic floor weakness always follow up with your GP or see a Women’s health physio for assessment.
CAESAREAN SECTION WOUND CARE
Drs Marren Campbell & Mackie use absorbable sutures or staples to repair the caesarean wound. This means it does not need removing. On some occasions a different suture material is used & this is removed in hospital on Day 5 or as advised by your doctor. All caesarean wounds are covered with a ‘Comfeel’ dressing. This dressing is removed by the patient at home usually 3 weeks after surgery. It is best removed after a shower – lift one corner & slowly pull the dressing away from the skin. It may pull a bit on any hair but will not damage the healing wound. Leaving the dressing on reduces risk of wound infection and skin is completely healed by 3 weeks.
Shower as normal and then dry the area carefully but thoroughly. If any redness & swelling & or oozing from the wound occurs in the postnatal period please talk to a medical professional. Once the skin is fully healed you can gently massage Vitamin E cream along the line of the scar every day.
After the baby is born most women will find their tummy to be soft & to have very little tone. Every day as the uterus shrinks and slowly returns to the pelvic cavity the tone will slowly improve. Diastasis of the Rectus Abdominus muscle is very common & in simple terms is separation of the abdominal muscle caused by the pressure of the growing uterus. This affects the functional strength of the abdominal wall, resulting in back pain & possible increase to pelvic girdle pain. There is a normal separation of 2 finger widths for all women in pregnancy. This will normally repair itself during the 6 week postnatal period. When the separation is greater than 2 finger widths a physio follow up is always advisable so that appropriate exercises can be explained so that normal function of the muscle can return. A midwife or a physio at the hospital should be able to assess your abdominal separation prior to discharge from hospital after you have your baby.
The linea nigra (brown line) in the middle of the abdomen may take some time to fade after the baby is born. Some women will not have complete resolve of the pigmentation.
When do they return? If you are not breastfeeding your cycle will usually return within 7 to 12 weeks of having your baby. This means, that women in this category could ovulate as early as 4 weeks after the birth of the baby! However, if you are breastfeeding they will more commonly return around 4 to 6 months after the birth. Those who are fully breastfeeding are more likely to have a delayed return of their period than those who combine breastfeeding with some formula feeds. As babies often start solids around six months, overtime they breastfeed less often & so this is the time the cycle will most likely return. There are some women who will not get a period until they have completely stopped breastfeeding. There is a very big range of normal but if you have any concerns it is always best to talk with your GP.
Breasts will fill with milk even if you have decided not to breastfeed. Women who decide not to breastfeed are advised to wear firm bras & reduce any stimulation to the breasts from showers etc. Ice packs & paracetamol will help with discomfort in the first few days after the baby is born. As the breasts are not emptied the pituitary gland in the brain will get the message not to keep up the milk supply so over a couple of weeks they will gradually soften & return to their non pregnant state. Increased pigmentation can take longer to fade.
Women who are breastfeeding will continue to have enlarged breast tissue and increased pigmentation. Once the decision to wean is made, it can take a few weeks for the breasts to return to their non pregnant state. It is very important to seek information on how to wean so as not to cause a breast infection such as mastitis. Information can be sourced from the Australian Breastfeeding Association website or the ABA counsellor phone service, the Early Childhood Nurse and or your GP.
It can take up to 40 days for the milk supply to fully resolve after the last breastfeed or express. The breasts will feel soft and non tender some time before this. If you have any concerns about lumps or other changes in your breasts whilst feeding or after you stop it is very important to seek medical advice as soon as possible. It is difficult to determine what bra size you may require after you stop breastfeeding & a refitting may be required as many women do not return to their former bra size.